Healthcare Provider Details

I. General information

NPI: 1427360627
Provider Name (Legal Business Name): ELEANOR PITZ KIELL M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ELEANOR LYNNE PITZ M.D.

II. Dates (important events)

Enumeration Date: 07/06/2010
Last Update Date: 05/03/2023
Certification Date: 05/03/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

MEDICAL CENTER BLVD
WINSTON SALEM NC
27157-4319
US

IV. Provider business mailing address

100 KIMEL FOREST DR
WINSTON SALEM NC
27103-6074
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4091
  • Fax: 336-716-7994
Mailing address:
  • Phone: 336-716-0238
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number2017-00456
License Number StateNC
# 2
Primary TaxonomyY
Taxonomy Code207YP0228X
TaxonomyPediatric Otolaryngology Physician
License Number2017-00456
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: